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目的分析近8年住院新生儿败血症构成比、病原菌分布及耐药性特点,为临床治疗提供参考。方法收集2007年1月至2014年12月我院新生儿科收治的败血症患儿临床资料,回顾性分析病原菌分布及耐药情况。结果共收治败血症患儿608例,占同期住院患儿的2.62%(608/23 224),其中确诊412例、临床诊断196例。前4年败血症住院构成比为2.29%(225/9 805),低于后4年的2.85%(383/13 419),差异有统计学意义(P<0.05)。共检出病原菌412株,革兰阳性菌(G~+菌)、革兰阴性菌(G~-菌)及真菌分别占62.38%、30.34%和7.28%。前4年检出病原菌155株,G~+菌、G~-菌及真菌分别为106株(68.39%)、40株(25.81%)、9株(5.81%),其中凝固酶阴性葡萄球菌(CONS)占G~+菌的90.57%,肺炎克雷伯菌及大肠埃希菌分别占G~-菌的50.00%和15.00%。后4年检出病原菌257株,G~+菌、G~-菌及真菌分别为151株(58.75%)、85株(33.07%)、21株(8.17%),其中CONS占G~+菌的74.83%,肺炎克雷伯菌及大肠埃希菌分别占G~-菌的30.58%和35.29%。前、后4年CONS及大肠埃希菌构成比比较,差异有统计学意义(P<0.05)。G~+菌对青霉素G、苯唑西林及大环内酯类普遍耐药,对哌拉西林他唑巴坦、喹诺酮类抗菌药物敏感性高,未发现万古霉素耐药菌株;G~-菌对氨苄西林及头孢菌素类抗菌药物普遍耐药,对β-内酰胺酶抑制剂复方制剂及喹诺酮类较敏感,对碳青霉烯类抗菌药物敏感性高;真菌对康唑类普遍敏感。结论新生儿败血症病原菌以CONS为主,其次为肺炎克雷伯菌及大肠埃希菌;主要G~+菌及G~-菌对青霉素及头孢类抗菌药物普遍耐药,主要G~+菌对万古霉素均敏感,主要G~-菌对碳青霉烯类抗菌药物敏感性高;真菌对康唑类药物普遍敏感。
Objective To analyze the constituent ratio of neonatal sepsis, the distribution of pathogens and the characteristics of drug resistance in recent 8 years, so as to provide reference for clinical treatment. Methods The clinical data of children with sepsis admitted from January 2007 to December 2014 in our department of neonatology were collected. The distribution of pathogens and drug resistance were retrospectively analyzed. Results A total of 608 cases of sepsis were treated, accounting for 2.62% (608/23 224) of the hospitalized children in the same period, of which 412 cases were diagnosed and 196 cases were clinically diagnosed. The hospitalization rate of sepsis in the first 4 years was 2.29% (225/9 805), which was lower than 2.85% (383/13 419) in the latter 4 years, the difference was statistically significant (P <0.05). A total of 412 pathogenic bacteria were detected, of which Gram - positive bacteria (G ~ +), Gram - negative bacteria (G ~ - bacteria) and fungi accounted for 62.38%, 30.34% and 7.28% respectively. 155 strains of pathogens were detected in the first 4 years, 106 strains (68.39%), 40 strains (25.81%) and 9 strains (5.81%) were positive for G ~ + bacteria, CONS accounted for 90.57% of G ~ + bacteria, Klebsiella pneumoniae and Escherichia coli accounted for 50.00% and 15.00% of G ~ - bacteria, respectively. 257 strains of pathogenic bacteria were detected in the last 4 years, 151 strains (58.75%), 85 strains (33.07%) and 21 strains (8.17%) were G ~ + bacteria, G ~ Of 74.83%, Klebsiella pneumoniae and Escherichia coli accounted for 30.58% and 35.29% of G ~ - bacteria, respectively. CONS and Escherichia coli before and after 4 years, the difference was statistically significant (P <0.05). G ~ + strains were generally resistant to penicillin G, oxacillin and macrolides, and were sensitive to piperacillin and tazobactam and quinolone antibacterials. No vancomycin resistant strains were found. G ~ The bacteria are generally resistant to ampicillin and cephalosporin antibiotics, are sensitive to the compound preparations of β-lactamase inhibitors and quinolones, and have high sensitivity to carbapenem antibiotics. The fungi are generally sensitive to the azadirachtin . Conclusions The main pathogens of neonatal sepsis are CONS, followed by Klebsiella pneumonia and Escherichia coli; the major G ~ + and G ~ - strains are generally resistant to penicillin and cephalosporin antibiotics, Vancomycin is sensitive, the main G ~ - bacteria susceptible to carbapenem antibacterials; fungi are generally sensitive to the azole drugs.